Nursing Elites

1. A healthcare professional is assessing a client who has been taking lithium carbonate for bipolar disorder. Which of the following findings should the professional report to the provider?

• A. Increased urination
• B. Tremors
• C. Weight gain
• D. Blurred vision

Correct answer: B

Rationale: Tremors are a concerning sign of lithium toxicity that indicate a potential overdose. Tremors can progress to more severe symptoms if not addressed promptly. Reporting tremors promptly allows the provider to assess the client's lithium levels, adjust the dosage, or provide appropriate interventions to prevent further complications. Increased urination, weight gain, and blurred vision are potential side effects of lithium but are not indicative of toxicity or overdose. While they should still be monitored, they are not as urgent as tremors in the context of lithium therapy.

2. The client with heart failure is prescribed furosemide (Lasix). Which electrolyte imbalance is the nurse most likely to monitor for?

• A. Hyperkalemia
• B. Hypernatremia
• C. Hypokalemia
• D. Hyponatremia

Correct answer: C

Rationale: The correct answer is C: Hypokalemia. Furosemide, a loop diuretic, commonly causes potassium loss, leading to hypokalemia. The nurse should closely monitor for decreased potassium levels in a client receiving furosemide to prevent complications such as cardiac arrhythmias or muscle weakness. Hyperkalemia (Choice A) is not typically associated with furosemide use. Hypernatremia (Choice B) refers to high sodium levels and is not the primary concern with furosemide. Hyponatremia (Choice D) is low sodium levels, which can occur but is less common than hypokalemia in clients taking furosemide.

3. A client with heart failure is being discharged with a prescription for digoxin (Lanoxin). The nurse should include which instruction in the discharge teaching?

• A. Take your pulse before each dose and hold the medication if your pulse is below 60 beats per minute
• B. Increase your fluid intake to at least 3 liters per day
• C. Report any weight loss of more than 2 pounds in a week
• D. Take the medication with meals to avoid gastrointestinal upset

Correct answer: A

Rationale: The correct instruction for a client taking digoxin is to monitor the pulse before each dose and hold the medication if the pulse is below 60 beats per minute. Digoxin can cause bradycardia, so it is crucial to assess the pulse rate before administration to prevent potential complications. Choices B, C, and D are incorrect because increasing fluid intake, reporting weight loss, or taking the medication with meals are not specific instructions related to the safe use of digoxin.

4. When teaching a client with a new prescription for spironolactone, which instruction should the nurse include?

• A. Increase your intake of potassium-rich foods.
• B. Avoid consuming grapefruit juice.
• C. Take the medication with food.
• D. Monitor for signs of hyperkalemia.

Correct answer: D

Rationale: The correct answer is to instruct the client to monitor for signs of hyperkalemia when taking spironolactone since it is a potassium-sparing diuretic. Hyperkalemia is a potential adverse effect due to the medication's mechanism of action. Advising the client to increase potassium-rich foods (Choice A) would be incorrect as it can further elevate potassium levels, which could lead to hyperkalemia. Avoiding grapefruit juice (Choice B) is not directly related to spironolactone use. Though taking the medication with food (Choice C) can help reduce gastrointestinal upset, it is not the most critical instruction when initiating spironolactone therapy.

5. The LPN/LVN is assisting with the care of a client who has been diagnosed with a myocardial infarction (MI). Which laboratory test result would the nurse expect to see elevated within the first 24 hours of the client's admission?

• A. Serum troponin
• B. Serum creatinine
• C. Serum sodium
• D. Serum albumin

Correct answer: A

Rationale: Elevated serum troponin levels are indicative of myocardial damage and are commonly used as a diagnostic marker for myocardial infarction. Troponin levels typically rise within a few hours of an MI and remain elevated for several days, making it a crucial test for early detection and monitoring of cardiac injury. Serum creatinine is not typically elevated in the acute phase of a myocardial infarction. Serum sodium and serum albumin levels are not directly associated with myocardial infarction and are unlikely to be elevated in the first 24 hours following an MI.

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